Kamrian Sue Wilson, OD
Individual provider Active NPI Optometrist · St. Robert, MO
NPI 1699702175 · NPPES record last updated Aug 27, 2014
Key facts
- NPI
- 1699702175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TO3060 (MO)
- Practice address
- 690 Missouri Ave.
Suite 22
St. Robert, MO 65584 - Phone
- (573) 336-4670
- Fax
- (573) 336-5968
- NPI assigned
- Jun 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Missouri St Louis - School of Optometry, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
690 Missouri Ave
Suite 22
Saint Robert, MO 65584-4680
Phone (573) 336-4670
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 26 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090227000102 | MO | Practitioner - Optometry | 7214093251 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TO3060 | MO | MD | Corneal and Contact Management Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyeglass Center LLC | Current |
Accepting new patients |
Locations
690 Missouri Ave
Ste 22
Saint Robert, MO 65584
Phone (573) 336-4670
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TO3060 | MO | Yes |
| Corneal and Contact Management Optometrist | 152WC0802X | TO3060 | MO |
Addresses
Primary practice location
690 Missouri Ave.
Suite 22
St. Robert, MO 65584
Mailing address
690 Missouri Ave.
Suite 22
St. Robert, MO 65584-4680
Phone (573) 336-4670
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 313540411 | Medicaid | MO | |
| 313540411MO | Medicaid | MO |
Other providers in St. Robert, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.